Regional differences in severe postpartum hemorrhage: A nationwide comparative study of 1.6 million deliveries

Background: The incidence of severe postpartum hemorrhage (PPH) is increasing. Regional variation may be attributed to variation in provision of care, and as such contribute to this increasing incidence. We assessed reasons for regional variation in severe PPH in the Netherlands. Methods: We used the Netherlands Perinatal Registry and the Dutch Maternal Mortality Committee to study severe PPH incidences (defined as blood loss ≥ 1000 mL) across both regions and neighborhoods of cities among all deliveries between 2000 and 2008. We first calculated crude incidences. We then used logistic multilevel regression analyses, with hospital or midwife practice as second level to explore further reasons for the regional variation. Results: We analyzed 1599867 deliveries in which the incidence of severe PPH was 4.5%. Crude incidences of severe PPH varied with factor three between regions while between neighborhoods variation was even larger. We could not explain regional variation by maternal characteristics (age, parity, ethnicity, socioeconomic status), pregnancy characteristics (singleton, gestational age, birth weight, pre-eclampsia, perinatal death), medical interventions (induction of labor, mode of delivery, perineal laceration, placental removal) and health care setting. Conclusions: In a nationwide study in The Netherlands, we observed wide practice variation in PPH. This variation could not be explained by maternal characteristics, pregnancy characteristics, medical interventions or health care setting. Regional variation is either unavoidable or subsequent to regional variation of a yet unregistered variable

VAST: An ASKAP Survey for Variables and Slow Transients

The Australian Square Kilometre Array Pathfinder (ASKAP) will give us an unprecedented opportunity to investigate the transient sky at radio wavelengths. In this paper we present VAST, an ASKAP survey for Variables and Slow Transients. VAST will exploit the wide-field survey capabilities of ASKAP to enable the discovery and investigation of variable and transient phenomena from the local to the cosmological, including flare stars, intermittent pulsars, X-ray binaries, magnetars, extreme scattering events, interstellar scintillation, radio supernovae and orphan afterglows of gamma ray bursts. In addition, it will allow us to probe unexplored regions of parameter space where new classes of transient sources may be detected. In this paper we review the known radio transient and variable populations and the current results from blind radio surveys. We outline a comprehensive program based on a multi-tiered survey strategy to characterise the radio transient sky through detection and monitoring of transient and variable sources on the ASKAP imaging timescales of five seconds and greater. We also present an analysis of the expected source populations that we will be able to detect with VAST.Comment: 29 pages, 8 figures. Submitted for publication in Pub. Astron. Soc. Australi

Appraising the Qualities of Social Work Students’ Theoretical Knowledge: A Qualitative Exploration

Van Bommel, M., Boshuizen, H. P. A., & Kwakman, K. (2012). Appraising the qualities of social work students' theoretical knowledge: A qualitative exploration. Vocations and Learning, 5, 277-295. doi:10.1007/s12186-012-9078-9Higher professional education aims to prepare students for entering practice with an adequate theoretical body of knowledge. In constructivist programmes, authentic learning contexts and self-directed learning are assumed to support knowledge learning and the transition from education to practice. Through an in-depth exploration, this case study aimed at defining and assessing the qualities of social work students’ theoretical knowledge at initial qualification. Participants were final-year bachelor’s students (n=18) in a constructivist professional programme of social work. Students’ knowledge concerning a real-life practical case was elicited through an interview and a form of concept mapping. A six-step procedure was used for a qualitative appraisal of students’ knowledge with the assistance of seven expert teachers. During this procedure an instrument for analysing knowledge qualities was developed, comprising 13 aspects representing four features of expert knowledge: extent, depth, structure, and critical control. Results showed that 13 students received high appraisals for their knowledge extent and depth. Only 4 students received high appraisals for knowledge structure and critical control. 5 Students who received overall lower appraisals seemed inhibited to show their knowledge qualities by preoccupations with self-concerns about their own professional role. Conclusion is that the majority of students needs more learning support for knowledge structure and critical control than offered by their constructivist programme. Further research is needed into the personal factors that influence students’ theoretical knowledge learning and which knowledge qualities can be reached by young adults in a four year educational programme.Hogeschool Arnhem Nijmege

Transcriptome Analysis of the Arabidopsis Megaspore Mother Cell Uncovers the Importance of RNA Helicases for Plant Germline Development

Germ line specification is a crucial step in the life cycle of all organisms. For sexual plant reproduction, the megaspore mother cell (MMC) is of crucial importance: it marks the first cell of the plant “germline” lineage that gets committed to undergo meiosis. One of the meiotic products, the functional megaspore, subsequently gives rise to the haploid, multicellular female gametophyte that harbours the female gametes. The MMC is formed by selection and differentiation of a single somatic, sub-epidermal cell in the ovule. The transcriptional network underlying MMC specification and differentiation is largely unknown. We provide the first transcriptome analysis of an MMC using the model plant Arabidopsis thaliana with a combination of laser-assisted microdissection and microarray hybridizations. Statistical analyses identified an over-representation of translational regulation control pathways and a significant enrichment of DEAD/DEAH-box helicases in the MMC transcriptome, paralleling important features of the animal germline. Analysis of two independent T-DNA insertion lines suggests an important role of an enriched helicase, MNEME (MEM), in MMC differentiation and the restriction of the germline fate to only one cell per ovule primordium. In heterozygous mem mutants, additional enlarged MMC-like cells, which sometimes initiate female gametophyte development, were observed at higher frequencies than in the wild type. This closely resembles the phenotype of mutants affected in the small RNA and DNA-methylation pathways important for epigenetic regulation. Importantly, the mem phenotype shows features of apospory, as female gametophytes initiate from two non-sister cells in these mutants. Moreover, in mem gametophytic nuclei, both higher order chromatin structure and the distribution of LIKE HETEROCHROMATIN PROTEIN1 were affected, indicating epigenetic perturbations. In summary, the MMC transcriptome sets the stage for future functional characterization as illustrated by the identification of MEM, a novel gene involved in the restriction of germline fate

Associations between depressive symptoms and disease progression in older patients with chronic kidney disease: results of the EQUAL study

Background Depressive symptoms are associated with adverse clinical outcomes in patients with end-stage kidney disease; however, few small studies have examined this association in patients with earlier phases of chronic kidney disease (CKD). We studied associations between baseline depressive symptoms and clinical outcomes in older patients with advanced CKD and examined whether these associations differed depending on sex. Methods CKD patients (>= 65 years; estimated glomerular filtration rate <= 20 mL/min/1.73 m(2)) were included from a European multicentre prospective cohort between 2012 and 2019. Depressive symptoms were measured by the five-item Mental Health Inventory (cut-off <= 70; 0-100 scale). Cox proportional hazard analysis was used to study associations between depressive symptoms and time to dialysis initiation, all-cause mortality and these outcomes combined. A joint model was used to study the association between depressive symptoms and kidney function over time. Analyses were adjusted for potential baseline confounders. Results Overall kidney function decline in 1326 patients was -0.12 mL/min/1.73 m(2)/month. A total of 515 patients showed depressive symptoms. No significant association was found between depressive symptoms and kidney function over time (P = 0.08). Unlike women, men with depressive symptoms had an increased mortality rate compared with those without symptoms [adjusted hazard ratio 1.41 (95% confidence interval 1.03-1.93)]. Depressive symptoms were not significantly associated with a higher hazard of dialysis initiation, or with the combined outcome (i.e. dialysis initiation and all-cause mortality). Conclusions There was no significant association between depressive symptoms at baseline and decline in kidney function over time in older patients with advanced CKD. Depressive symptoms at baseline were associated with a higher mortality rate in men

A multi-country test of brief reappraisal interventions on emotions during the COVID-19 pandemic.

The COVID-19 pandemic has increased negative emotions and decreased positive emotions globally. Left unchecked, these emotional changes might have a wide array of adverse impacts. To reduce negative emotions and increase positive emotions, we tested the effectiveness of reappraisal, an emotion-regulation strategy that modifies how one thinks about a situation. Participants from 87 countries and regions (n = 21,644) were randomly assigned to one of two brief reappraisal interventions (reconstrual or repurposing) or one of two control conditions (active or passive). Results revealed that both reappraisal interventions (vesus both control conditions) consistently reduced negative emotions and increased positive emotions across different measures. Reconstrual and repurposing interventions had similar effects. Importantly, planned exploratory analyses indicated that reappraisal interventions did not reduce intentions to practice preventive health behaviours. The findings demonstrate the viability of creating scalable, low-cost interventions for use around the world

Identification of genetic variants associated with Huntington's disease progression: a genome-wide association study

Background Huntington's disease is caused by a CAG repeat expansion in the huntingtin gene, HTT. Age at onset has been used as a quantitative phenotype in genetic analysis looking for Huntington's disease modifiers, but is hard to define and not always available. Therefore, we aimed to generate a novel measure of disease progression and to identify genetic markers associated with this progression measure. Methods We generated a progression score on the basis of principal component analysis of prospectively acquired longitudinal changes in motor, cognitive, and imaging measures in the 218 indivduals in the TRACK-HD cohort of Huntington's disease gene mutation carriers (data collected 2008–11). We generated a parallel progression score using data from 1773 previously genotyped participants from the European Huntington's Disease Network REGISTRY study of Huntington's disease mutation carriers (data collected 2003–13). We did a genome-wide association analyses in terms of progression for 216 TRACK-HD participants and 1773 REGISTRY participants, then a meta-analysis of these results was undertaken. Findings Longitudinal motor, cognitive, and imaging scores were correlated with each other in TRACK-HD participants, justifying use of a single, cross-domain measure of disease progression in both studies. The TRACK-HD and REGISTRY progression measures were correlated with each other (r=0·674), and with age at onset (TRACK-HD, r=0·315; REGISTRY, r=0·234). The meta-analysis of progression in TRACK-HD and REGISTRY gave a genome-wide significant signal (p=1·12 × 10−10) on chromosome 5 spanning three genes: MSH3, DHFR, and MTRNR2L2. The genes in this locus were associated with progression in TRACK-HD (MSH3 p=2·94 × 10−8 DHFR p=8·37 × 10−7 MTRNR2L2 p=2·15 × 10−9) and to a lesser extent in REGISTRY (MSH3 p=9·36 × 10−4 DHFR p=8·45 × 10−4 MTRNR2L2 p=1·20 × 10−3). The lead single nucleotide polymorphism (SNP) in TRACK-HD (rs557874766) was genome-wide significant in the meta-analysis (p=1·58 × 10−8), and encodes an aminoacid change (Pro67Ala) in MSH3. In TRACK-HD, each copy of the minor allele at this SNP was associated with a 0·4 units per year (95% CI 0·16–0·66) reduction in the rate of change of the Unified Huntington's Disease Rating Scale (UHDRS) Total Motor Score, and a reduction of 0·12 units per year (95% CI 0·06–0·18) in the rate of change of UHDRS Total Functional Capacity score. These associations remained significant after adjusting for age of onset. Interpretation The multidomain progression measure in TRACK-HD was associated with a functional variant that was genome-wide significant in our meta-analysis. The association in only 216 participants implies that the progression measure is a sensitive reflection of disease burden, that the effect size at this locus is large, or both. Knockout of Msh3 reduces somatic expansion in Huntington's disease mouse models, suggesting this mechanism as an area for future therapeutic investigation

Automutilations chroniques: des patient/es difficiles

Patientinnen mit chronischer Selbstbeschädigung stellen eine Gruppe schwieriger Patientinnen dar, die häufig wenig zu einer psychiatrischen oder psychotherapeutischen Behandlung motiviert sind. Nach dem Versuch einer klinischen Einteilung wird auf ein psychoanalytisches Konzept zur Psychodynamik selbstverletzenden Verhaltens eingegangen. Abschließend wird das Schema der KOMEPP (Kontext orientierte Modellentwicklung bei einer Psychotherapieplanung) vorgestellt und mögliche therapeutische Probleme im Umgang mit dieser schwierigen Patientinnengruppe diskutiert.Schlüsselwörter: Chronische Selbstbeschädigung, Psychotherapie.atients with self mutilation behavior represent a group of difficult patients, who are often less motivated for psychiatric or psychotherapeutic treatment. After attempting a clinical classification we discuss a psychoanalytical, psychodynamic concept of self-mutilation behavior. Finally a new concept (KOMEPP) of a context oriented development of models for planning psychotherapy is presented and different psychotherapeutic problems dealing with this special group of patients are discussed.Keywords: Self-mutilation behavior, psychotherapy.Lorsqu’un/e patient/e se blesse volontairement, son environnement proche a de multiples réactions émotionnelles: consternation, sentiment d’impuissance, horreur et peur.Du fait que les patient/es souffrant de sérieux troubles de la personnalité représentent une proportion croissante de la clientèle des institutions, mais aussi des cabinets de psychothérapie, la question de savoir comment gérer adéquatement les évolutions chroniques dans lesquelles les patients s’automutilent gagne en importance. Avant d’accepter de traiter ce genre de patient en ambulatoire et dans le cadre d’un cabinet privé, il faut poser un diagnostic clair et définir sans équivoque le contexte du traitement.Nous traitons ci-dessous de la manière dont une psychothérapie peut être planifiée en fonction de l’élaboration d’un modèle tenant compte de son contexte. Cette approche doit permettre de préparer le traitement de patients difficiles en associant à sa planification leur environnement familial et psychosocial, ceci durant l’élaboration du modèle et le projet de psychothérapie déjà.La manière dont Herpertz et Sass (1994) proposent de définir l’automutilation chronique nous semble utile: “Par automutilation chronique manifeste, on entend toutes les blessures physiques que le/la patient/e s’inflige, exception faite de celles qui visent à entraîner la mort. Le patient comme ses proches savent que c’est celui-ci qui a causé la blessure.” Cette définition exclut les comportements qui ont des effets néfastes indirects (fumer, par ex.), ainsi que l’abus de nourriture ou de boissons nuisibles à la santé.Du point de vue clinique, on effectue une distinction entre des formes relativement peu sérieuses (coupures superficielles, petites brûlures, égratignures, morsures, coups sur la tête ou les extrémités, manipulation de plaies, brûlures causées par des substances alcalines ou acides, trichotilomanie, extraction d’ongles etc.) et d’autres formes plus graves (ablation de l’œil, castration, mutilation des mamelons, amputation d’une extrémité).De notre point de vue, il faut inclure dans cette catégorie diagnostique les comportements autodestructeurs qui provoquent des atteintes physiques: infection ou lésions dermiques artificielles, saignements, ainsi que les hypo- et hyperglycémies provoquées sciemment par des patients diabétiques, etc.Le service de traitement ambulatoire des automutilations chroniques établi dans le cadre de la Clinique universitaire de psychologie des profondeurs et de psychothérapie de l’Université de Vienne a développé un schéma, sur la base duquel une psychothérapie peut être planifiée- la “Kontextorientierte Modellentwicklung bei einer Psychotherapieplanung”, KOMEPP (Schuster et al., 1998, en préparation). L’utilisation de ce schéma permet souvent de créer les conditions rendant possible l’offre d’un traitement psychothérapeutique à ce groupe de patients difficiles.Lors du processus menant à un premier entretien on tente de définir, avec le/la patient/e, les variables qui vont favoriser le traitement. La discussion des problèmes se fait sur des bases multiprofessionnelles et multiécoles et tente de saisir les points saillants du contexte. Ceci implique que les professionnels qui se sont déjà occupés du patient (médecins, assistantes sociales, psychothérapeutes) et les personnes appartenant à son contexte social (famille, enseignants, assistants sociaux etc.) collaborent directement à l’élaboration d’un modèle de psychothérapie. Durant la phase qui précède la planification du traitement, toutes les personnes faisant partie de l’environnement du patient participent donc à la discussion, ce qui permet de préparer un modèle individuel de traitement.Une planification soigneuse de la psychothérapie permet ensuite d’appliquer ce modèle. Les patient/es souffrant de sérieux troubles de la personnalité sont souvent incapables de gérer la thérapie. Lorsque des problèmes se présentent dans leur environnement social, leur famille, avec leurs enfants, etc. ce sont souvent une assistante sociale ou un médecin qui assument cette fonction. L’unique possibilité de mener une psychothérapie avec ces patients difficiles implique fréquemment que l’on confie à une personne 'externe’ la tâche de gérer le traitement, de le coordonner et de servir de 'centre de décision’. Du point de vue de son contenu, nous considérons qu’une thérapie d’orientation psychanalytique doit viser à mettre en évidence les aspects ayant une fonction psychologique qui sont contenus dans les actes d’automutilation. Le patient qui se voyait contraint d’agir (dans un sens destructif) doit pouvoir faire l’expérience de et verbaliser ces contenus, découvrant leur signification dans le cadre d’une interaction avec le thérapeute. Initialement, il va sans doute refuser cette signification; mais en cours de thérapie, elle pourra être intégrée dans l’ensemble de sa personnalité. Du fait que les patient/es dont nous parlons souffrent souvent de graves troubles de la personnalité, les pronostics ne peuvent pas être trop optimistes - et pourtant une psychothérapie à long terme représente souvent la seule chance de traitement